Procedure and Transportation Codes Billing Limitations
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- Cecil Bishop
- 8 years ago
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1 Procedure and Billing Limitations Treatment Services That Can Not be Billed on Same Day Procedure Psychotherapy, 30 minutes with patient and/or family member Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) * Indicates service may be allowable in addition to HCTC if billed with an override 1 and documented in the Client's medical record Revised 10/3/2013
2 Procedure and Billing Limitations Psychotherapy, 45 minutes with patient and/or family member That Can Not be Billed on Same Day Procedure Psychotherapy, 45 minutes with patient and/or family memberwhen performed with an evaluation and management service (list separately in addition to the code for primary procedure) * Indicates service may be allowable in addition to HCTC if billed with an override 2 and documented in the Client's medical record Revised 10/3/2013
3 Procedure and Billing Limitations Psychotherapy, 60 minutes with patient and/or family member That Can Not be Billed on Same Day Procedure Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (list separately in addition to the code for primary procedure) * Indicates service may be allowable in addition to HCTC if billed with an override 3 and documented in the Client's medical record Revised 10/3/2013
4 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Interactive complexity (list separately in addition to the code for primary procedure Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report * Indicates service may be allowable in addition to HCTC if billed with an override 4 and documented in the Client's medical record Revised 10/3/2013
5 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a problem-focused history; a problem-focused examination; and, straightforward medical decision-making. (Approx 10 min) Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: expanded problem-focused history; an expanded problem-focused exam; and straightforward medical decision-making. (Approx 20 min) * Indicates service may be allowable in addition to HCTC if billed with an override 5 and documented in the Client's medical record Revised 10/3/2013
6 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a detailed history; a detailed examination; and, medical decision-making of low complexity. (Approx 30 min) Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and, medical decision-making of moderate complexity. (Approx 45 min) * Indicates service may be allowable in addition to HCTC if billed with an override 6 and documented in the Client's medical record Revised 10/3/2013
7 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and, medical decision-making of high complexity. (Approx 60 min) Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services. * Indicates service may be allowable in addition to HCTC if billed with an override 7 and documented in the Client's medical record Revised 10/3/2013
8 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making. (Approx 10 min) Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision-making of low complexity. (Approx 15 min) * Indicates service may be allowable in addition to HCTC if billed with an override 8 and documented in the Client's medical record Revised 10/3/2013
9 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision-making of moderate complexity. (Approx 25 min) Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. (Approx 40 min) * Indicates service may be allowable in addition to HCTC if billed with an override 9 and documented in the Client's medical record Revised 10/3/2013
10 Procedure and Billing Limitations Observation care discharge day management. That Can Not be Billed on Same Day Procedure Initial observation care, per day, for the evaluation and management of a patient which requires the three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity. * Indicates service may be allowable in addition to HCTC if billed with an override 10 and documented in the Client's medical record Revised 10/3/2013
11 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity Initial observation care, per day, for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. * Indicates service may be allowable in addition to HCTC if billed with an override 11 and documented in the Client's medical record Revised 10/3/2013
12 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office consultation for a new or established patient, which requires these 3 key components: a problem-focused history; a problem-focused examination; and medical decision-making for a minor presenting problem. (Approx. 15 minutes) Office consultation for a new or established patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision-making for problems of a low severity. (Approx. 30 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 12 and documented in the Client's medical record Revised 10/3/2013
13 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office consultation for a new or established patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision-making for a problem of low complexity. (Approx. 40 minutes) Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity for problems of a moderate/high severity. (Approx. 60 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 13 and documented in the Client's medical record Revised 10/3/2013
14 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Office consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making for a problem of a high severity. (Approx. 80 minutes) Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making. Presenting problem(s) are self-limited or minor. * Indicates service may be allowable in addition to HCTC if billed with an override 14 and documented in the Client's medical record Revised 10/3/2013
15 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making for a problem of low complexity. Presenting problem(s) are of low to moderate severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making for a problem of moderate complexity. Presenting problem(s) are of moderate severity. * Indicates service may be allowable in addition to HCTC if billed with an override 15 and documented in the Client's medical record Revised 10/3/2013
16 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity. Presenting problem(s) are of high severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision- making of high complexity. Presenting problem(s) are of high severity. * Indicates service may be allowable in addition to HCTC if billed with an override 16 and documented in the Client's medical record Revised 10/3/2013
17 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Evaluation and management of a new or established patient involving an annual nursing facility assessment which requires these 3 components: a detailed interval history; a comprehensive examination; and medical decision making that is straightforward or of low complexity. (Approx. 30 minutes) Evaluation and management of a new or established patient involving a nursing facility assessment which requires these 3 components: a detailed interval history; a comprehensive examination; and medical decision making of moderate to high complexity. (Approx. 40 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 17 and documented in the Client's medical record Revised 10/3/2013
18 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Evaluation and management of a new or established patient involving a nursing facility assessment at the time of initial admission or readmission to the facility, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision making of moderate to high complexity. (Approx. 50 minutes) Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem and the patient's and/or family's needs. Usually the problem(s) requiring admission are of low severity * Indicates service may be allowable in addition to HCTC if billed with an override 18 and documented in the Client's medical record Revised 10/3/2013
19 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Usually, the problem(s) requiring admission are of moderate severity Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Usually, the problem(s) requiring admission are of high severity * Indicates service may be allowable in addition to HCTC if billed with an override 19 and documented in the Client's medical record Revised 10/3/2013
20 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; straightforward medical decision making. Usually the patient is stable, recovering, or improving Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity. Usually, the patient is responding inadequately to therapy or has developed a minor complication * Indicates service may be allowable in addition to HCTC if billed with an override 20 and documented in the Client's medical record Revised 10/3/2013
21 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision making of moderate complexity. Usually, the patient has developed a significant complication or a significant new problem Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; medical decision making of high complexity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention * Indicates service may be allowable in addition to HCTC if billed with an override 21 and documented in the Client's medical record Revised 10/3/2013
22 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Nursing facility discharge day management, 30 minutes or less Nursing facility discharge day management, more than 30 minutes * Indicates service may be allowable in addition to HCTC if billed with an override 22 and documented in the Client's medical record Revised 10/3/2013
23 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Evaluation and management of a patient involving an annual nursing facility assessment, which requires these three key components: a detailed interval history; a comprehensive examination; and medical decision making that is of low to moderate complexity. Usually, the patient is stable, recovering, or improving , 99305, 99306, 99307, 99308, 99309, 99310,99315, Domiciliary or rest home visit for the evaluation and management of a new patient which requires these 3 key components: a problem-focused history; a problem-focused examination; and, medical decision-making for a problem of low severity. (Approx 20 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 23 and documented in the Client's medical record Revised 10/3/2013
24 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient which requires these 3 key components: an expanded problemfocused history; an expanded problem-focused examination; and, medical decision-making for a moderately severe problem Domiciliary or rest home visit for the evaluation and management of a new patient which requires these 3 key components: a detailed history; a detailed examination; and, medical decision-making for a problem of high severity. (Approx. 50 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 24 and documented in the Client's medical record Revised 10/3/2013
25 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes with the patient an/or family or caregiver Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 25 and documented in the Client's medical record Revised 10/3/2013
26 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 26 and documented in the Client's medical record Revised 10/3/2013
27 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: a problem-focused interval history; a problem-focused examination; and, medical decision-making for a patient who is stable or improving. (Approx. 15 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 27 and documented in the Client's medical record Revised 10/3/2013
28 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: an expanded problem-focused interval history; an expanded problem-focused examination; and, decision-making for a patient who is responding inadequately or for a minor complication. (Approx. 25 minutes) Domiciliary or rest home visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: a detailed interval history; a detailed examination; and, decision-making regarding unstable patient/significant complication/new problem. (Approx. 35 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 28 and documented in the Client's medical record Revised 10/3/2013
29 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; straightforward medical decision making. Usually, the presenting problem(s) are self-limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 29 and documented in the Client's medical record Revised 10/3/2013
30 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver. Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; and medical decision making of moderate to high complexity. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver. * Indicates service may be allowable in addition to HCTC if billed with an override 30 and documented in the Client's medical record Revised 10/3/2013
31 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of a new patient which requires these 3 key components: a problem-focused history; a problem focused examination; and medical decision-making for a low severity problem. (Approx. 20 minutes) Home visit for the evaluation and management of a new patient which requires 3 key components: an expanded problem-focused history; and expanded problem-focused examination; and medical decision-making for a moderately severe problem. (Approx. 35 minutes) * Indicates service may be allowable in addition to HCTC if billed with an override 31 and documented in the Client's medical record Revised 10/3/2013
32 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of a new patient which requires 3 key components: a detailed history; a detailed examination; and decision-making for a highly severe problem. (Approx. 45 minutes) Home visit for the evaluation and management of a new patient, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity. (Approx 60 min) * Indicates service may be allowable in addition to HCTC if billed with an override 32 and documented in the Client's medical record Revised 10/3/2013
33 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of a new patient, which requires these three components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity. (Approx 75 min) Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused interval history; a problem-focused examination; straightforward medical decision-making. (Approx 15 min) * Indicates service may be allowable in addition to HCTC if billed with an override 33 and documented in the Client's medical record Revised 10/3/2013
34 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision-making of low complexity. (Approx 25 min) Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed interval history; a detailed examination; medical decision-making of moderate complexity. (Approx 40 min) * Indicates service may be allowable in addition to HCTC if billed with an override 34 and documented in the Client's medical record Revised 10/3/2013
35 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive interval history; a comprehensive examination; medical decision-making of moderate to high complexity. (Approx 60 min) Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour. (List separately in addition to code for office or other outpatient evaluation and management service) * Indicates service may be allowable in addition to HCTC if billed with an override 35 and documented in the Client's medical record Revised 10/3/2013
36 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting). [Use for each additional 30 min in conjunction with 99354] H0001 Alcohol and/or drug assessment H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 36 and documented in the Client's medical record Revised 10/3/2013
37 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0002 Behavioral health screening to determine eligibility for admission H0018 H0031 Mental health assessment / by Non-Physician H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 37 and documented in the Client's medical record Revised 10/3/2013
38 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0004 Office, individual behavioral health counseling and therapy, per 15 minutes H0004 Home, individual behavioral health counseling and therapy, per 15 minutes * Indicates service may be allowable in addition to HCTC if billed with an override 38 and documented in the Client's medical record Revised 10/3/2013
39 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0004 Office, family behavioral health counseling and therapy with client present per 15 minutes HR H0004 Office, family behavioral health counseling and therapy without client present per 15 minutes HS * Indicates service may be allowable in addition to HCTC if billed with an override 39 and documented in the Client's medical record Revised 10/3/2013
40 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0004 Out of office, family behavioral health counseling and therapy with client present per 15 minutes HR H0004 Out of office, family behavioral health counseling and therapy without client present per 15 minutes HS * Indicates service may be allowable in addition to HCTC if billed with an override 40 and documented in the Client's medical record Revised 10/3/2013
41 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is bassed on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education H2033 H2033 Multisystemic therapy for juveniles, per 15 minutes H0015 Rehabilitation Services * Indicates service may be allowable in addition to HCTC if billed with an override 41 and documented in the Client's medical record Revised 10/3/2013
42 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2014 * Individual skills training and development, per 15 minutes H2017, H0018, S5109HB, S5109HC, S5109HA H2014 * Group skills training and development, per 15 minutes per person HQ H2017, H0018,, S5109HB, S5109HC, S5109HA * Indicates service may be allowable in addition to HCTC if billed with an override 42 and documented in the Client's medical record Revised 10/3/2013
43 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2017 * Psychosocial rehabilitation living skills training services, per 15 minutes H2014, H2014HQ, H0018, S5109HB, S5109HC, S5109HA H0025 Behavioral health prevention/promotion education service (services to target population to affect knowledge, attitude and/or behavior) H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 43 and documented in the Client's medical record Revised 10/3/2013
44 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0034 Medication training and support H0018 H2025 Ongoing support to maintain employment, per 15 minutes H2026, H2027 * Indicates service may be allowable in addition to HCTC if billed with an override 44 and documented in the Client's medical record Revised 10/3/2013
45 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2026 Ongoing support to maintain employment, per diem H2025, H2027 H2027 Psychoeducational service (pre-job training and development), per 15 minutes H2025, H2026 * Indicates service may be allowable in addition to HCTC if billed with an override 45 and documented in the Client's medical record Revised 10/3/2013
46 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure T1002 RN services, up to 15 minutes T1003 LPN services, up to 15 minutes Support Services * Indicates service may be allowable in addition to HCTC if billed with an override 46 and documented in the Client's medical record Revised 10/3/2013
47 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure T1013 Sign language or oral interpretive services T1019 * Personal care service, per 15 minutes, not for inpatient or residential care facilities S5109HB, S5109HC, S5109HA, H0018, T1020 * Indicates service may be allowable in addition to HCTC if billed with an override 47 and documented in the Client's medical record Revised 10/3/2013
48 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure T1020 Personal care services, per diem, not for an inpatient or residential care facilities S5109HB, S5109HC, S5109HA, H0018, T1019, S5151 S5110 * Home care training, family; per 15 minutes S5109HB, S5109HC, S5109HA H0038 Self-help/peer services, per 15 minutes H2016 H2016 Comprehensive community support services, per diem H0038, H0038 HQ H0038 Self-help/peer services group, per 15 minutes HQ H2016 S5109HB Home care training to home care client, per session (adult) S5109HC, S5109HA, T1019, T1020, H0018, H2014, H2014HQ, H2017,S5110, S5151 * Indicates service may be allowable in addition to HCTC if billed with an override 48 and documented in the Client's medical record Revised 10/3/2013
49 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure S5109HC Home care training to home care client, per session (adult geriatric) S5109HB, S5109HA, T1019, T1020, H0018, H2014, H2014HQ, H2017,S5110, S5151 S5109HA Home care training to home care client, per session (child) S5109HB, S5109HC, T1019, T1020, H0018, H2014, H2014HQ, H2017, S5110, S5151 * Indicates service may be allowable in addition to HCTC if billed with an override 49 and documented in the Client's medical record Revised 10/3/2013
50 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure S5150 Unskilled respite care, not hospice; per 15 minutes H0018, S5151 S5151 Unskilled respite care, not hospice; per diem H0018, S5109HB, S5109HC, S5150, S5109HA Crisis Behavioral Health Services * Indicates service may be allowable in addition to HCTC if billed with an override 50 and documented in the Client's medical record Revised 10/3/2013
51 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure S9484 Crisis intervention mental health service, per hour S9485 S9485 Crisis intervention mental health service, per diem H0018, S9484 * Indicates service may be allowable in addition to HCTC if billed with an override 51 and documented in the Client's medical record Revised 10/3/2013
52 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2011 Crisis intervention service, per 15 minutes H2011 Crisis intervention service via 2 person team, per 15 minutes HT Behavioral Health Day Programs * Indicates service may be allowable in addition to HCTC if billed with an override 52 and documented in the Client's medical record Revised 10/3/2013
53 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2012 Supervised behavioral health day treatment, per hour H0018, H2015, H2019, H2019TF, H2020, H0036, H0036TF, H0037 H2015 Comprehensive community support services, supervised day program, per 15 minutes H0018, H2012, H2019, H2019TF, H2020, H0036, H0036TF, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 53 and documented in the Client's medical record Revised 10/3/2013
54 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2019 Therapeutic behavioral services day program, per 15 minutes H0018, H2012, H2015, H2019TF, H2020, H0036, H0036TF, H0037 H2019 Therapeutic behavioral services day program, per 15 minutes (min. of 3 hours and less than 6 hours) TF H0018, H2012, H2015, H2019, H2020, H0036, H0036TF, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 54 and documented in the Client's medical record Revised 10/3/2013
55 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2020 Therapeutic behavioral services, per diem H0018, H2012, H2015, H2019, H2019TF, H0036, H0037, H0036TF H0036 Community psychiatric supportive treatment day program, face-to-face, per 15 minutes H0018, H2012, H2015, H2019, H2019TF, H2020, H0036TF, H0037, * Indicates service may be allowable in addition to HCTC if billed with an override 55 and documented in the Client's medical record Revised 10/3/2013
56 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0036 Community psychiatric supportive treatment medical day program, face-toface, per 15 minutes TF H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0037, H0037 Community psychiatric supportive treatment medical day program, per diem H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0036TF Behavioral health day programs-home * Indicates service may be allowable in addition to HCTC if billed with an override 56 and documented in the Client's medical record Revised 10/3/2013
57 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H2019 Home therapeutic behavioral services day program, per 15 minutes TF H0018, H2012, H2015, H2019, H2020, H0036, H0036TF, H0037 H2020 Home therapeutic behavioral health day services, per diem H0018, H2012, H2015, H2019, H2019TF, H0036, H0036TF, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 57 and documented in the Client's medical record Revised 10/3/2013
58 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0036 Home community psychiatric supportive medical treatment, face-to-face, per 15 minutes H0018, H2012, H2015, H2019, H2019TF, H2020, H0036TF, H0037 H0036 Home community psychiatric supportive medical treatment, face-to-face, per 15 minutes TF H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0037 * Indicates service may be allowable in addition to HCTC if billed with an override 58 and documented in the Client's medical record Revised 10/3/2013
59 Procedure and Billing Limitations That Can Not be Billed on Same Day Procedure H0037 Home community psychiatric supportive medical treatment program, per diem H0018, H2012, H2015, H2019, H2019TF, H2020, H0036, H0036TF Residential Services H0043 Supported Housing H0018 * Indicates service may be allowable in addition to HCTC if billed with an override 59 and documented in the Client's medical record Revised 10/3/2013
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